Healthcare Provider Details

I. General information

NPI: 1497000384
Provider Name (Legal Business Name): BEVERLEY DONNA HENRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 REMINGTON PLACE
NEW ROCHELLE NY
10801
US

IV. Provider business mailing address

124 REMINGTON PL
NEW ROCHELLE NY
10801-3902
US

V. Phone/Fax

Practice location:
  • Phone: 914-235-0761
  • Fax: 914-235-0761
Mailing address:
  • Phone: 914-235-0761
  • Fax: 914-235-0761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number472153
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number472153
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: